45 y/o trans woman interested in body feminization - which procedures would you recommend? (photos)

Question

Hi, I'm 45 years old transgender woman. I'm very interested to feminize my whole body with the 360 bbl. Any recommendations? Here are a few pictures in different angles. Thanks in advance.

Justin Yovino, MD, FACS · Answer

Yes, I agree! Thorough liposculpting of your abdomen, waist, hips, flanks, and back with an emphasis on enhancing your curves appears to be a great option for you. Transferring that fat to the buttocks and adjacent areas will further elevate the results. We perform these Precision Sculpt®️ Awake Butt Lift®️ procedures in the office under safe local anesthesia with oral sedation. We can start with a virtual consultation if you’d like or come visit us in person.

Mats Hagstrom, MD (license on probation) · Answer

For your torso, liposuction and fat transfer are the only realistic options. There may be a few providers who will steer you towards implants, but the great majority of plastic surgeons in the United States do not offer or recommend gluteal or hip implants. The most important decision you were going to make is choosing the right provider. Not only does skill and experience very quiet dramatically among plastic surgeons, but their approach to what looks good or how the procedure should be done varies substantially as well. Determining the transition point where above that line fat is removed, and below that line fat is added, is critical in getting a quality BBL results. In your case, I would also recommend building up your outer thigh to create more of an hourglass, a.k.a. coke bottle, a.k.a. S-curve feminized body. 
You should view the BBL as a single procedure. If these procedures are not done correctly, the first time, the chance of ending up with a quality outcome is almost always lost. Some improvements can always be made with revision surgery, but generally, this is very much a do it right and do it once type of procedure.
The number of plastic surgeons usually mastered this procedure, or in a very small minority. It takes a lot of effort to find the right provider, and finding the right provider makes all the difference and will impact you every day for the rest of your life.
I recommend patients start the process by scheduling multiple in person consultations. Start by making a list of local providers who seem to do a lot of the BBL procedures. During each consultation, ask each provider to open up their portfolio and show you Adair entire collection of before and after pictures of previous patients who had similar body characteristics to your own. And experience plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patience. I highly experienced surgeon should have hundreds or even thousands of before and after pictures to choose from.
Mastering this procedure requires a total dedication and many years of experience. Doing liposuction and fat transfer is inherently not difficult, but doing it while on a consistent basis and getting predictable outcomes is not easy or straightforward. Most plastic surgeons think they’re far better at Liposuction and then they actually are. There are unfortunately a substantial number of providers with proper credentials, good reviews, and reputations, who simply don’t know how to do liposuction well.
When it comes to reviewing fat, transfer results always confirm the timeframe of when after pictures were taken. Early fat transfer results like the BBL can look very impressive, but do not in any way. Represent final results. Final results pictures that should never be taken less than 3 to 6 months from the date of surgery. Do not assume after pictures are mature, final outcomes. Always ask the exact timeframe on when after pictures were taken when reviewing before and after pictures with providers.
Take careful notes during each consultation, especially regarding the quantity and quality of the before and after pictures. It is your responsibility to vet the provider for both your liposuction and fat grafting skills. The best and easiest way to get a good idea of what your results are going to look like is to see an endless number of before, and after pictures of previous patients done by the same provider who had similar body characteristics to your role.
Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like or what the variation and discrepancy in outcome is in the hands of each provider.
There’s no correct number of consultations needed to find the right provider. Considering how much variation there is an skills and experience for both Liposuction and fat transfer, I recommend starting by having at least five consultations before committing to a permanent, irreversible body contouring procedure that can potentially leave you disfigured. 
You seem like a good candidate for the procedure so now the only variable left is finding the right provider. I don’t see any good alternative treatments for body transformation. Please recognize that the appearance of your thighs and legs are critical to how the torso is viewed. You need to include the lower extremities in all pictures. Each body area looks the way it does only in context to the surrounding body parts. The torso only looks the way it does in comparison to the buttocks thighs and legs. Even if your torso has a transformation necessary if your thighs appear masculine the transition for not be successful unless the thigh is properly addressed. This may require grafting fat almost down to your knee.
When making an assessment for someone’s S-curve i usually view their torso from their knee to their armpit. I also do most of the body contouring with patients laying on their sides to put the S-curve on full view and accentuate those curves ideally. Almost all BBL work is done with patients in the prone position, but I found the patience being up on their side, helps me get better results, especially true when the emphasis is on the hips and thigh. The hips and thighs look drastically different when someone’s laying on their abdomen. Simply positioning patients correctly during surgery. Can I have a big impact on how the surgery is performed and what the potential outcome is.
Continue having consultations until you feel quite confident you found the right plastic surgeon for your needs. Best,
Mats Hagstrom, MD

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